Open Complete Mesocolic Excision with Central Vascular Ligation Versus Laparoscopic Approach in Right Colon Cancer Patients

Abstract

Background:Complete mesocolic excision (CME) as a standard surgery for right sided colon cancer is proven however there is a great debate and deal of discussion if the extra effort needed for it in right sided colon cancer worth the gain that is achieved. We aimed in our study to assess the outcome of CME with central vascular ligation for treatment of right sided colon cancer performed either laparoscopic (lap.) assisted or by open technique.

Methods: Twenty-two patients with right colonic cancer were assigned to receive complete mesocolic excision with central vascular ligation in (Zagazig university hospitals) in the period from February, 2018 till February, 2020. Eleven cases for open approach and 11 cases for laparoscopic approach and their data were prospectively collected.

Results:the operative time in our study ranged from 120-210 minutes in open cases and 180-240 minutes in laparoscopic cases. The mean blood loss was 350±54.7 ml in open cases and 195.5±41.6 ml in laparoscopic cases and no intraoperative complications like ureteric or bowel injuries were recorded.The hospital stay ranged from 6 to 13 days in open cases and 4 to 6 days in laparoscopic cases and oral feeding was allowed in the second or third postoperative day in most of the patients.Clear advantages have been demonstrated for the laparoscopic approach in term of decreased intra-operative blood loss, faster post-operative recovery & return of bowel function, decreased pain, decreased hospital stay and improved quality of life.As regard post-operative complications, all patients were managed conservatively. Chest physician consultation for cases of chest infection and they improved with antibiotic treatment after, wound infection was noted in 6 patients of open group and it was superficial infection that had been treated easily. One patient developed UTI and was successfully treated and one case of abdominal collection for which US guided aspiration was done.

Conclusion: Short-term oncologic results of laparoscopic CME seem to be acceptable and outcome seems to be better than those obtained in other studies with conventional resection as laparoscopic procedure maintains intact embryological envelope of the mesocolon and allows high tight ligation